Trigeminal neuralgia
Trigeminal neuralgia is a chronic pain condition that affects the Trigeminal nerve and its branches, the Ophthalmic, Maxillary and Mandibular nerves, which are responsible for facial sensations, such as touch, warmth, vibration, etc.
Neuralgia is the medical term for pain that follows the path of a nerve.
Patients with this disease suffer from severe and sporadic pain crisis in the area innervated by this nerve. These episodes last from a few seconds to 2 minutes and might be triggered by innocent actions such as talking, chewing, or touch.
There are three main subtypes of this disease, according to its cause:
- Classical Trigeminal Neuralgia — when a vein or artery is touching the nerve and damaging it
- Secondary Trigeminal Neuralgia — when there is a disease known to cause these pain episodes, such as multiple sclerosis
- Idiopathic Trigeminal Neuralgia — includes all the other cases. Idiopathic means that we still don’t know what is the cause of the disease.
Treatment
Trigeminal neuralgia can be treated with medication and with surgery.
Medication is usually the first choice but is not curative. Carbamazepine or oxcarbazepine are effective drugs to control symptoms long-term. They are commonly associated with epilepsy treatment but are useful in many more diseases. Many other drugs like lamotrigine, phenytoin, or baclofen might be helpful.
When a pain crisis occurs, patients can go to the hospital to be treated with intravenous phenytoin or lidocaine, so the pain is controlled as fast as possible. This treatment is not as well established as the long-term treatment with carbamazepine. Very few studies have addressed this question.
Surgical treatment is less frequent due to the risks of brain surgery. Generally, it is only performed when there is a vascular structure (vein or artery) damaging the nerve, intending to separate those two structures with a pad.
Other types of surgery, for example, the destruction of a part of the nerve with heat or a toxic substance, can also be performed.
Secondary trigeminal neuralgia implies the existence of an underlying disease or condition which is responsible for this neuralgia. Therefore, treatment of this type of trigeminal neuralgia includes the treatment of that underlying disease.
Complications
Patients with trigeminal neuralgia have a higher risk of suffering from lack of sleep and depression. Harmless gestures, like touching, eating, or brushing the teeth, can trigger a severe pain episode. Therefore, these patients avoid situations that can trigger facial pain, leading to social isolation and impaired quality of life.
